OP0040 CHANGES IN BODY WEIGHT AND BODY COMPOSITION IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS AGED 65+ TREATED WITH 2-YEAR LOW-DOSE ADD-ON PREDNISOLONE IN THE RANDOMISED DOUBLE-BLIND PLACEBO-CONTROLLED GLORIA TRIAL
Authors: M. Güler-Yüksel, M. Kuijper, R. Bos, E. Molenaar, J. Emmering, S. Eshuis, H. Adams, F. Reimann, M. Boers, M. R. Kok
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Weight gain is one of the most feared patient-reported adverse event of glucocorticoids, however the effect of low-dose prednisolone on body weight and composition in RA still has to be unraveled. <h3>Objectives</h3> Current study is a substudy of the GLORIA trial.<sup>[1]</sup> We report changes in body weight of the whole study population, and relate these to changes in disease activity, and changes in body composition in a subgroup of patients. <h3>Methods</h3> The GLORIA trial, a pragmatic, placebo-controlled, double-blind, randomised controlled trial investigated the balance of benefit and harm of 2 years of prednisolone 5 mg/day added to standard care in 451 patients with active RA aged 65+.<sup>[1]</sup> In current study 449 patients were included, and body weight and disease activity score of 28 joints (DAS28) were measured at baseline and after 3, 6, 12, 18 and 24 months. In 57 patients body composition was assessed at baseline and after 2 years with dual-energy X-ray absorptiometry. Data were analysed with longitudinal mixed models, and log-ratio analysis to evaluate the mutual changes in body composition, given as the proportions total lean mass, total fat mass, and total bone mass. <h3>Results</h3> Body weight changed by mean (95% CI) 0.9 (0.3;1.6) kg on prednisolone after 2 years, versus –0.4 (–1.1;0.2) kg on placebo, with a difference between treatment groups of 1.3 (0.5;2.2) kg (p&lt;0.01). In multivariable regression analysis, the effect of AUC DAS28 0–2 years was not significantly associated with weight change (p=0.18). The change in body composition after 2 years was different in prednisolone compared to placebo patients (log-ratio analysis, p=0.02; Table 1). Prednisolone patients showed small but favorable changes in body composition, i.e. lean mass increases exceeding fat mass increases, with trends in differences for total lean mass and lean mass index, and even significant differences for appendicular lean mass (p=0.02), and its corresponding index (p&lt;0.01). No differences in change were seen in total fat mass, nor in fat distribution over the body, i.e. trunk, extremities and head (log-ratio analysis, p=0.93). <h3>Conclusion</h3> Patients with active RA aged 65+ treated with prednisolone 5 mg/day for 2 years gained about 1 kg in weight, compared to non-significant weight loss on placebo. This weight gain is a direct effect of the glucocorticoid treatment, and not significantly dependent of decrease in disease activity. The small increase in weight is mostly (appendicular) lean mass, rather than increase or redistribution of fat mass traditionally associated with glucocorticoid treatment. <h3>Reference</h3> [1]Boers M, et al; GLORIA Trial consortium. Low dose, add-on prednisolone in patients with rheumatoid arthritis aged 65+: the pragmatic randomised, double-blind placebo-controlled GLORIA trial. Ann Rheum Dis. 2022. <h3>Acknowledgements</h3> We thank all patients and trial collaborators – listed in previous published main manuscript of the GLORIA trial – for their participation in the trial.21 We thank the nuclear medicine department of the Maasstad hospital, Medical Center Leeuwarden and Groene Hart hospital (all in the Netherlands) for performing the bodyscans. <h3>Disclosure of Interests</h3> None Declared.